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Hyperglycemia and kidney outcomes in critically ill children and young adults on continuous kidney replacement
Shrea Goswami1, Katja M Gist2, Petter Bjornstad3
1Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Hyperglycemia in children undergoing continuous kidney replacement therapy (CKRT) is linked to poorer kidney outcomes. Elevated glucose levels (≥180 mg/dL) increased the risk of death or persistent kidney dysfunction within 90 days.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Metabolic Disorders
Background:
- Limited research exists on hyperglycemia's impact on children receiving continuous kidney replacement therapy (CKRT).
- This study investigates the association between hyperglycemia and kidney outcomes in critically ill children with acute kidney injury (AKI) or fluid overload undergoing CKRT.
Purpose of the Study:
- To evaluate the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT.
- To identify potential glucose thresholds associated with adverse kidney outcomes.
Main Methods:
- Secondary analysis of the multicenter retrospective WE-ROCK study.
- Primary exposure: hyperglycemia (average serum glucose ≥150 mg/dL) during days 0-7 of CKRT.
- Primary outcome: MAKE-90 (death by 90 days or persistent kidney dysfunction).
Main Results:
- 48% of participants experienced hyperglycemia (average glucose >150 mg/dL).
- Hyperglycemia was associated with higher mortality rates (44% vs. 32%) and longer hospital stays.
- Average glucose ≥180 mg/dL was linked to increased adjusted odds of MAKE-90 (aOR: 1.44).
Conclusions:
- Hyperglycemia is associated with worse kidney outcomes in pediatric patients on CKRT.
- Further research is needed to establish causality and optimal glucose targets in this population.
Background:
There are limited studies evaluating hyperglycemia in children treated with continuous kidney replacement therapy (CKRT). We evaluated the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT for acute kidney injury (AKI) or fluid overload.
Methods:
Secondary analysis of the multicenter retrospective observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study (34 centers, 9 countries). Primary exposure was hyperglycemia on days 0-7 of CKRT (average serum glucose of ≥ 150 mg/dL). Average serum glucose < 150 mg/dL was defined as euglycemic. We stratified the hyperglycemic group with cut-offs ≥ 180 mg/dL, ≥ 200 mg/dL, or ≥ 250 mg/dL. The primary outcome was MAKE-90 (death by 90 days or persistent kidney dysfunction [> 125% baseline serum creatinine, or dialysis dependence]).
Results:
Of 985 participants, 48% (473) had average serum glucose > 150 mg/dL during days 0-7 of CKRT. There were higher rates of death in the hyperglycemic group (44% vs. 32%, p < 0.001) and longer length of stay among survivors (42 vs. 38 days, p = 0.017) compared to the euglycemic group. Those with average glucose ≥ 150 mg/dL had higher unadjusted odds of MAKE-90 (OR: 1.36, 95% CI 1.02-1.81); this finding did not remain after multivariate adjustment. Those with average glucose ≥ 180 mg/dL had higher adjusted odds of MAKE-90 (aOR: 1.44, 95% CI 1.02-2.04). In adjusted analysis, each 10 mg/dL increase in glucose was associated with 3% increased odds of MAKE-90.
Conclusions:
Hyperglycemia is associated with worse kidney outcomes among young persons on CKRT for AKI or fluid overload. Further studies are needed to evaluate the causality and determine appropriate glucose ranges in this high-risk population.
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